The traditional arguments don’t seem to apply in the case of Nadya Suleman, the 33 yo woman who delivered 8 babies last week after undergoing IVF. Normally, I would say “stop targeting a single mom and focusing a disproportionate amount of attention on her.” But the fact that Ms. Suleman is a single mom actually matters. Who will help her care for 14 young children? Apparently Ms. Suleman’s parents have their hands completely full taking care of the 6 she already has, while Nadya is in the hospital recovering. The fact that she is not married should not be the issue, but rather whether both she and the children will have adequate social support.

However, the support she receives can be dictated by our social response. Recall that when Nkem Chukwu had octuplets following IVF in 1998, she was given a great deal of corporate support through free diapers and a new home. Was the public enthusiasm there because she was married, religiously motivated to keep all of the children, because this was novel, or because we were in better economic times in 1998, when access to government resources was not on everyone’s lips? (One thing that interests me is that we really know nothing about why Ms. Suleman decided to keep all 8 embryos, rather than selectively terminating some, but perhaps because we know she is single, people are making all kinds of assumptions about what her reasoning must have been).

The second argument I would pull from the archives would be, “We don’t want to turn into China with the government regulating how many children we each have. Let her decide whether IVF is a good option for her…we don’t know her unique circumstances.” But we do know she already had 6 kids through IVF. Can it really be that the government would allow a physician to insert 8 embryos into this woman, knowing the serious risks it would pose not just to her, but also to the developing fetuses?

During an interview on MSNBC, Ms. Suleman’s neighbors brought up the big elephant in the room, that few ethicists want to talk about, which is the cost. Who is going to pay for the health care and education of these children? This is related to the paragraph above, as state-sponsored, utilitarian assessments of how many children we can conceive would probably not pass a 14th Amendment substantive due process challenge, and it would appropriately be met with a very strong (and negative) social response.

Ms. Suleman has hired a spokesperson, who says that the mother did not know she would be having multiple births, and it was just as much a “surprise to her” as it was to everyone else. This cannot be true, unless the IVF clinician was negligent in explaining the process to her. If Ms. Suleman had 6 babies previously through IVF, and she knew she had 8 embryos implanted this time, she had to at least be aware of the strong possibility of having more than one child. But should we be investigating her motives or decision making process at all, or should we just focus on the potential harm to her and to her children?

Should it matter that she already had undergone IVF, and is the public outcry in response to a sense that she is “being greedy?” Recall that the Duggar family, highlighted on the show “17 Kids and Counting” had even more children, though none were conceived using IVF. On the show’s website, the Duggar’s choice is explained this way: “With values rooted in their strong personal faith, Jim Bob and Michelle firmly believe that every child is a gift to be cherished.” Why were they a “pop culture phenomenon” and generally well received, when Ms. Suleman is being publicly shamed? Surely it cannot be because their births were “natural.” Relying on what’s natural in this case confuses the issues – first, because the word is almost meaningless, and second, because we do not shame any number of other medical interventions that interrupt the “natural” course of our lives. What’s different here? Perhaps the difference between the two families is that Ms. Suleman is single and her support system has been questioned (though, I cannot claim to know what it will actually be – for all I know she has a huge support system of extended family…)

What should be done in these delicate situations, where we want to balance the privacy and liberty rights of the mom-to-be against the rights of the children she will be raising, and the government’s interest in protecting them? Should there be a limit on the number of embryos that can be implanted if it’s your first time? Or only if it’s your second time using IVF? Should we rely on tort law to sue negligent IVF clinicians, or should we have tighter regulations in place at these clinics for the safety of the mom and the babies?

Please send us your thoughts, and let’s hope that the babies and the new mom continue to do well. Right now as she recovers and attends to her small children, I hope she is insulated from all of the public shaming. – Teneille

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p.s. – Thanks to Dov Greenbaum for directing me to the article, IVF Results: Optimize, Not Maximize. As David Magnus points out in the MSNBC link above, there are lots of professional norms about implating embryos, and implanting 8 is apparently well outside of the norm. Could this be malpractice if it’s outside of the standard of care? Absent any legal bite, there will be clinicians who will push the ethical limits.

4 responses to “Questioning the Shaming of Nadya Suleman”

There are so many interesting questions here. Things like this always make me consider how you can’t force people to be responsible by making laws. So few of the questions surrounding this event seem to me to be legal ones, which is in itself interesting.

One area you brought up where there is a legal issue to discuss caught my eye: It is my understanding that there are guidelines, but no regulation, surrounding how many embryos can be implanted. The doctor who did the implantation is under a lot of scrutiny right now for what seems like a disregard of guidelines. Regulating a medical procedure like embryo implantation doesn’t seem to have quite the challenges (constitutional and otherwise) of regulating number of children a woman is allowed to have — might there be some benefit to such rules? It seems to me likely to protect women’s health, potential infants’ health, and the resources of our already suffering healthcare and educational systems if we tried to curb not number of children allowed, but number allowed at one time through artificial, controllable means.

In the mean time, I hope all involved can be as healthy as possible. I also add my wish that Ms. Suleman will find a way to pay for all of her family’s needs without allowing the media to exploit her and especially her children. Yet another area where so many behave irresponsibly, without the prospect of legal repercussions… a can of worms for another day.

I think the biggest distinction between her and
the other cases you have noted is her irrational
behavior in light of her financial circumstances.
She intentionally got impregnated again using an expensive treatment(IVF ) when she already had
no means to support her existing children except welfare.
Also she used money allocated for support of her existing children to get impregnated and get plastic surgery.
I believe after this case many new guidelines will be put into place and should be. When one
wants to buy a car ,house one needs to
prove that they can pay for it through means
of employment .Same conditions should
be in place here. Also one should have
some type of medical insurance so the burden
isn’t also placed on society.
Nadya knew 4 weeks into her pregnancy
it was a multiple birth pregnancy but
was adament not to selectively terminate
any children. Regardless if she had 1 or 8
embryos it should have never taken place
due to her inability to care for her other children. Her parents pleade d with her
Dr to not do IVF on her due to hers and there
financial situation.

Hi there – I agree that there may be significant distinctions between Ms. Suleman’s situation and those of the other large families mentioned above. This post was written before Ms. Suleman had spoken to the public, and perhaps needs to be updated in light of what we now know (i.e., that one clinic was involved in both IVF procedures, and that she definitely had at least 6 embryos implanted). At the time of writing, this was speculation.

Do you think we need tighter legal regulations on IVF clinicians? Or are you satisfied with the professional sanctions that the IVF clinician is receiving (he’s being investigated by the relevant medical board)? Is that enough to deter future negligent conduct? Please give us your thoughts!

Jethro66’s comment suggests a need for change — but it doesn’t seem like a change in healthcare regulations. It seems like a change in some sort of financial regulation — about how money can be used when it was designated for a certain purpose. These are economic complaints, not really bioethical complaints. Does one woman’s irrational behavior (that is widely recognized as such) really mean that we need a whole slew of regulations? Won’t there always be a few irrational people out there? As a society, I don’t believe we can or should be the captives of the very few who will always find ways. And the price of that might be that a few people get away with things.

Returning to the question of regulation on IVF clinicians, it seems to me that it would be too difficult to regulate who can can’t can’t have what type of IVF procedure in a fair way. A rule limiting the number of embryos that can be implanted to, say, 3 or 4, might actually infringe on the reasonable liberties of a woman who was young and healthy who had previous trouble getting embryos to take. And simply setting age brackets wouldn’t work, because age is only one of the factors determining a mother’s fitness and the safety of the procedure — in the end, it really needs to be an individual medical decision, and only doctors who know the patients involved can really decide what is and isn’t safe and appropriate in any given case. A doctor who performs a procedure acknowledged to be unsafe can be disciplined by existing systems, as is happening now.

It’s hard to know exactly where things went wrong for Ms. Suleman — perhaps in many places along the way — but I wonder if one possible step might be to require more, or even more specific, information to be given to prospective patients, much in the way that women seeking abortion are required to be counseled about the procedure in many states. Don’t some states even dictate the content of the materials that must be either given or made available to women undergoing that procedure? Perhaps a similar rule for IVF would prevent women from becoming pregnant with “extreme multiples” without having previously been aware (as Ms. Suleman claims she was not) of the likelihood of that outcome and the health consequences for herself and her babies. Perhaps including something about the cost could address the very edge of the economic concern.